job description
Are you a licensed Medical Doctor looking to transition into a non-clinical role while leveraging your medical expertise? Rumah Sakit Pondok Indah Group, a leading healthcare provider in Indonesia, is seeking a Medical Claim Analyst to join our dynamic team in Bali.
This unique opportunity allows you to apply your clinical knowledge in a corporate setting, focusing on health insurance claim analysis, validation, and approval. You will play a pivotal role in ensuring accurate and fair claim processing while maintaining compliance with medical and regulatory standards.
Based in the vibrant regions of Canggu, Ubud, Denpasar, Jimbaran, Nusa Dua, Kuta, or Badung, this position offers a rewarding career path with competitive compensation, professional growth, and the chance to contribute to Indonesia’s evolving healthcare insurance landscape.
Responsibility
- Review and analyze medical insurance claims for accuracy, completeness, and compliance with policy terms.
- Assess the medical necessity of treatments, procedures, and hospitalizations based on clinical guidelines.
- Collaborate with healthcare providers, insurers, and internal teams to resolve claim discrepancies.
- Provide expert medical opinions on complex or high-value claims to support decision-making.
- Ensure timely processing of claims while adhering to regulatory and company policies.
- Identify patterns in claim denials or fraudulent activities and recommend preventive measures.
- Maintain up-to-date knowledge of medical coding (ICD-10, CPT) and insurance industry trends.
- Generate reports and documentation to support claim audits and appeals.
Qualifications
- Medical Doctor (MD) degree from an accredited institution; active medical license in Indonesia.
- Minimum 2 years of clinical experience (preferably in general practice, internal medicine, or surgery).
- Strong understanding of medical terminology, diagnostics, and treatment protocols.
- Familiarity with health insurance policies, claim processing, and medical billing is a plus.
- Excellent analytical, communication, and problem-solving skills.
- Proficiency in Microsoft Office (Excel, Word) and claim management software.
- Ability to work independently and in a team, with a high attention to detail.
- Fluency in English and Indonesian (written and verbal).